MEDICARE: MS. PHOEBE PELKEY P.A.-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	0550030608	VT
2	363A00000X	Physician Assistant	035190-01	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	59179	OTHER	VT	BLUE SHIELD ID NUMBER

General Provider Information

NPI Number	:	1811990104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PHOEBE PELKEY P.A.-C

Provider Business Mailing Address
First Line	:	372 DORSET ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403-6212
Country	:	US
Telephone Number	:	802-660-8808
Fax Number	:	802-660-4310

Provider Business Practice Location Address
First Line	:	372 DORSET ST
Second Line	:
City	:	SOUTH BURLINGTON
State	:	VT
Zip	:	05403
Country	:	US
Telephone Number	:	802-660-8808
Fax Number	:	802-660-4310

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	02/03/2026

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